Symptomatic extracranial internal carotid artery aneurysm deferred repair.

Extracranial carotid artery aneurysm is a rare condition (0.3-0.6% of the population), yet it has a significant cost to public health as the aneurysm is often revealed by stroke. Open and endovascular management of this condition have already been described, but no optimal treatment strategy could have been determined due to the lack of data. We present a case of a symptomatic extracranial internal carotid artery aneurysm revealed by an ischemic Sylvian stroke, followed shortly by a parenchymal haemorrhage. Surgery had to be postponed for ten weeks due to the initial risk of massive haemorrhagic transformation. To prevent thromboembolic event in the preoperative period, we introduced aspirin at first. It was replaced by tinzaparin when regression of parenchymal haemorrhage was assessed by control-computerised tomography (CT) 35 days later. No thromboembolic event happened during the preoperative period, up to Day 70 when surgery was performed. Aneurysm was successfully repaired with prosthetic polytetrafluoroethylene interposition bypass. The only complication observed was a transient XIIth cranial nerve injury due to large mobilisation during the surgery. No other neurological or cardiovascular event happened during nine months in the postoperative follow-up period. Literature about extracranial carotid artery aneurysm is scarce, mostly composed of small cases series. More data are needed to ascertain an optimal treatment strategy. In this optic, we report a case of an extracranial internal carotid artery aneurysm successfully treated surgically, after three weeks of antiplatelet therapy followed by seven weeks of anticoagulant therapy.

Multi-organ failure caused by lasagnas: A case report of Bacillus cereus food poisoning.

We report a Bacillus cereus, cereulide producing strain, food poisoning of two sisters. After eating a few bites of pasta cooked 3 days earlier, a 13-year-old girl developed mild symptoms. However, her 11-year-old sister suffered, 40 h after ingestion of the entire platter, a multi-organ failure including acute liver failure, rhabdomyolysis, disseminated intravascular coagulation, and acute kidney injury (AKI). She received supportive care in pediatric intensive care using mechanical ventilation, hemofiltration, and high-doses vasopressors. She was specifically treated for toxin-mediated disease using blood purification and further digestive decontamination. This report highlights the potential severity of B. cereus food poisoning but also a successful dual treatment including toxin removal and antimicrobial treatment to prevent toxin production.